CPT code 96567: Photodynamic therapy, incident-to treatment2026 Medicare rate & RVUs in Massachusetts
Reports an external-light photodynamic treatment using a photosensitizing agent to destroy premalignant lesions of the skin or adjacent mucosa.
Medicare pays $136.03–$154.24 for 96567 in the office in Massachusetts, from Rest of Massachusetts to Metropolitan Boston, MA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 96567 covers
This service treats premalignant lesions, commonly actinic keratoses on sun-damaged skin such as the face or scalp, with a photosensitizing agent followed by external illumination. The treatment is typically furnished in a dermatology office, with clinical staff performing the service under physician supervision. The light activates the agent in the treated area to damage the targeted abnormal cells.
Report one unit for each treatment, rather than one unit per lesion. Documentation should identify the treated area, photosensitizing agent, light treatment, and physician supervision. Under the CMS rule for this code, Medicare billing is limited to performance under physician supervision as an incident-to service. When a physician or other qualified health care professional performs the photodynamic treatment, distinguish that service from this staff-performed code and consider 96573. Separate lesion debridement performed to prepare for photodynamic therapy may be reported with 96574 when supported by the documentation.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 96567 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $154.24 | Unavailable |
| Rest of Massachusetts | $136.03 | Unavailable |
How the 96567 rate is calculated
Each of 96567’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 96567
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense3.86
3.86 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
3.8700
Conversion factor
$33.4009
Medicare rate
$129.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96567
The CMS indicators that decide how 96567 is paid alongside other services.
CMS payment indicators · 96567
Photodynamic therapy, incident-to treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
96567 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96573Photodynamic therapyIncludes agent application
- Both describe external-light photodynamic treatment of premalignant lesions. 96567 is the incident-to service under physician supervision; 96573 is for treatment performed by a physician or other qualified health care professional.
- 96574Lesion debridementFor photodynamic therapy
- 96574 describes debridement that prepares premalignant lesions for photodynamic therapy, not the photosensitizer-and-light treatment itself.
- 17000Premalignant lesion destructionFirst lesion
- 17000 describes destruction of a first premalignant skin lesion using a method other than photodynamic therapy. Use 96567 when the documented treatment uses a photosensitizing agent and external light.
96567 billing questions
Is 96567 reported for each lesion?
No. Report one unit for each photodynamic treatment, not for each individual actinic keratosis or other treated lesion.
How does 96567 differ from 96573?
96567 is the incident-to service performed under physician supervision. Use 96573 when the physician or other qualified health care professional performs the external-light photodynamic treatment.
Does 96567 require physician supervision?
Yes. CMS identifies this as an incident-to service and permits billing only when it is performed under physician supervision.
Can debridement be reported with the photodynamic treatment?
When a physician or other qualified health care professional separately performs debridement to prepare premalignant lesions for photodynamic therapy, 96574 may describe that service. Document the debridement and its relationship to the treatment.
When might a destruction code be used instead?
Codes such as 17000 describe lesion destruction by methods other than photodynamic therapy. Choose the code that matches the procedure actually performed, not simply the diagnosis.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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